[Effect of intramedullary nailing of tibial shaft fractures on the pressure in the deep posterior compartment of the leg]. / Wplyw zespolenia zlamania kosci piszczelowej gwozdziem sródszpikowym na cisnienie sródtkankowe w przedziale tylnym glebokim goleni.

In the years of 2003-2005 there was carried out an investigation on 24 patients (17 male and 7 female) based on measuring the pressure in the deep posterior compartment during tibial intramedullary nailing with reaming. The pressure was checked in each part of the operation. The mean increase of the pressure was 7% (+ 1.6 mmHg) and didn't cause any risk of compartment syndrome. In our opinion the intramedullary nailing might be consider as a safe procedure.

Interosseous ligaments and TFCC lesions in intraarticular distal radius fractures - radiographic versus arthroscopic evaluation.

Background. Intraarticular distal radius fractures are marked by a significant amount of soft tissue damage, which is not always noticed on routine X-rays. The lack of early diagnosis and treatment of these lesions can lead to the development of carpal instability, and subsequently to limited range of motion or wrist pain syndrome. The purpose of this article is to show how these lesions can be diagnosed arthroscopically, and at the same time to compare arthroscopic evaluation to standard X-rays. Material and methods. In the period from August 2004 to April 2005 we performed 21 wrist arthroscopies in 20 patients with intraarticular distal radius fractures (7 women and 13 men, ranging in age from 20 to 63 years, average age 38). Results. In all these patients, numerous soft tissue lesions were found during arthroscopic examination: TFCC lesions in 13 patients, SL ligament lesions in 7 patients, and an LT ligament lesion in 1 case. None of these lesions were visible in X-rays. An ulnar styloid fracture was found in 9 cases, in 4 cases associated with TFCC lesions. Loose bodies, not seen in previous X-rays, were detected in 8 patients. Conclusions. Arthroscopy in intraarticular distal radius fractures facilitates the diagnosis and treatment of soft tissue lesions, which are numerous and usually not detected on standard X-rays.

[Meniscuses and ligaments injuries in tibial plateau fractures in comparative evaluation of clinical, intraoperative and MR examination]. / Uszkodzenia lakotek i wiezadel w zlamaniach blizszej nasady piszczeli w porównawczej ocenie obrazu klinicznego, sródoperacyjnego i MR.

The diagnosis of the meniscal and ligament injuries accompanying the tibial plateau fractures is difficult and unconvincing. Thus the capsular, ligament and meniscal injuries coexisting with this kind of fractures were questioned for many years. Introducing of MR afforded for the precise evaluation of the bone as well as the soft tissue injury. This article demonstrates the results of MR images of 112 patients with the acute proximal tibia fractures. The number and the degree of the meniscal and ligament injury were estimated and intraoperative verification of MR was made in 66 patients qualified for an operative procedure. The attempt to find the correlation between the type of the fracture and the meniscal and ligament injury was made according to Schatzker classification. MR images revealed that the bone injury was accompanied by the ligament or meniscal injury in 88%. Most commonly the partial tears (77% considering ligament injuries and 70% considering meniscal injuries) occurred. The most frequent extracapsular and intracapsular injury was MCL tear (70%) and LM tear (56%) respectively. No correlation between the type of the fracture and the soft tissue injury was found.

[Removal of broken interlocking nails and reosteosynthesis--related clinical problems]. / Problem usuwania i reosteosyntezy po zlamaniu ryglowanych gwozdzi sródszpikowych.

Nine patients with six fractures of the intramedullary cannulated nails and four Gamma nails are presented. In five patients broken implants had been removed by simple and safe method by use of tape extractor and than four patients has had intramedullary reosteosynthesis by closed method. The main causes in most cases were technical errors and early full weighbearing.

[Familial nail patella-syndrome]. / Zespól paznokciowo-rzepkowy w trzypokoleniowej rodzinie.

Nail patella-syndrome is a rare hereditary (autosomal dominant) disorder resulting from a heterogenous loss of function in the LMXB1 gene on chromosome 9q34. It is associated with multiple deformities. Patients have a characteristic tetrad of pathologic symptoms including fingernail dysplasia, hypoplastic or absence patella, radial head dislocation, iliac horns and in some cases nephropathy and ophtalmo-logical findings (glaucoma). In this study four affected members in one family are presented. All of the familly members presented absence or hypoplastic patella and fingernails dysplasia. There were not indications for surgical treatment dislocated radial heads or subluxated dysplastic patella. Genetic counseling is recomended because nail patella syndrome is an autosomal dominant disease.

[Dislocation after total hip arthroplasty]. / Zwichniecia calkowitych endoprotez stawu biodrowego.

From 1997 to 2002 in the Department of Traumatology there had been performed 488 total hip replacements: 334 in men and 454 in women at the age between 20 and 84 (average 63.6). The procedures were performed by 12 surgeons and postero-lateral approach was used. Dislocation was found in 22 patients (4.51%): 14 women and 8 men. Majority of dislocation occurred during first 8 weeks after an operation and 68% of them happened during first 6 weeks. The surgical treatment was necessary in 10 cases (45% of all dislocation): 3 patients had only a surgical reposition and 7 patients had a revision arthroplasty. There was found that most cases of dislocation took place at the age above 81 years. Dislocation occurred 5 times more frequently in patients operated on for a femoral neck fractures then for coxarthrosis. The prosthesis TT1 most often dislocated possibly due to its shape (low Head Neck Ratio). Based on our own experience we find dislocation is a multifactorial complication and precise description of causes is usually very difficult.

[Quadriceps and hamstring atrophy and weakness after knee trauma and treatment]. / Oslabienie i zanik miesni prostowników i zginaczy po urazach i operacjach w obrebie stawu kolanowego.

158 patients after the knee trauma and operational treatment were evaluated. Quadriceps and hamstring isometric strength and thigh circumference 10 cm above the patella were measured. Injured leg was compared to non-injured. PATIENT GROUPS: Group 1 - 43 patients with isolated ACL injury treated non-operatively. Group 2 - 29 patients after ACL reconstruction using Leeds-Keio prosthesis. Group 3 - 29 patients after subtotal arthroscopic meniscectomy. Group 4 - 13 patients with patellar fractures treated operatively and 6 weeks in long leg cast, Group 5 - 31 patients with proximal articular tibial fractures treated operatively and immobilized 6 weeks in long leg cast. Group 6 - 13 patients with distal femoral articular fractures treated operatively without immobilization. Group 7 - 10 patients with habitual dislocation of the patella after the Campbell-Goldwaith operation and 6 weeks in a long leg cast. CONCLUSIONS: 1) No significant correlation between the quadriceps and hamstring strength deficit and thigh atrophy was found. 2) Strength deficits concerns both quadriceps and hamstring muscles. 3) Strength deficits are higher in patients treated in the long leg casts than in non-immobilized.

[Total elbow arthroplasty]. / Endoprotezoplastyka totalna stawu lokciowego.

The authors describe indications and contraindications for total elbow arthroplasty. The brief characteristic of total elbow replacement is done. The authors describe its own case of clinical use of the Coonrad-Morrey implant.

[Bipolar radial head prosthesis--own design]. / Endoproteza bipolarna glowy kosci promieniowej wlasnego pomyslu.

The authors describe its own design--bipolar radial head prosthesis. The value of this prosthesis is analyzed. The early results in 10 patients, age 20-69 (average 36 years), 7 male and 3 female have been reported. The results are excellent and good. The authors conclude that this prosthesis should be used as an alternative for radial head resection.

[The value of laser Doppler examination of differential diagnosis of the Sudeck syndrome with local osteoporosis after tibia fracture]. / Wartosc badania laserowo-dopplerowskiego w diagnostyce róznicowej choroby Sudecka z miejscowa osteoporoza po zlamaniach goleni.

The fractures of the shaft of the tibia were analyzed in 120 cases. The level of the osteoporosis in the radiological examination was assessed in comparison to the healthy limb. Osteoporosis was recorded in 60.6% of the cases. The clinical symptoms of the Sudeck syndrome was recorded in 11.25% of the cases. The Laser-Doppler examination was carried out in 120 cases. A standard 3 points measurement was employed: the apex of the toe, the flexion-dorsal part of the foot, and the medial part of the mid tibia length. The examination was done comparatively on both limbs. The pressure used in the occlusion, was 100 mm Hg higher than the pressure on the humeral artery. A faster and higher amplitude post-occlusion circulation reaction in the affected limb, among the patients with an early stage of the clinically diagnosed Sudeck syndrome had been recorded. The outcome is significant statistically. The Laser-Doppler measurement of the microcirculation is a new method and definite conclusions must be draw with caution. However, these results encourage further research.

The management of patients over 65 years of age with proximal humerus fractures.

Background. In patients older than 65 with osteoporosis, fractures of the proximal end of the humeral bone pose a difficult clinical problem. There is a larger body of opinion, however, favoring conservative treatment, while surgical intervention is most often reserved for complicated fractures.
Material and methods. We studied 186 patients treated in the Traumatology Clinic at the Center for Post-Graduate Medical Education over the last 5 years.
Conclusions. Our analysis showed that in osteoporotic fractures of the proximal epiphysis of the humeral bone there are very limited indications. As a general rule the best effects are achieved by the shortest possible duration of immobilization and early intervention.

Methods of operative treatment of proximal femur fractures in elderly patients with osteoporosis.

Introduction. Progressive osteoporosis as a cause of bone fractures is a serious clinical and social problem.
Material and methods. We studied 465 elderly patients treated surgically for fractures of the proximal femur. 3rd and 4th-degree fractures of the femoral neck according to the Garden scale were operated by Austin-Moore hemiarthroplasty or total hip replacement. In unstable peritrochanteric fractures, intramedullary Gamma nail osteosynthesis was applied in 69 patients, which allows for early mobilization and full weight-bearing. This method minimizes possible complications and mortality.
Results. There were no fatal complications during post-surgery hospitalization. Two patients over 80 years of age suffered decubitus ulcers. Re-osteosynthesis was not required after intramedullary Gamma nail osteosynthesis. In long-term follow-up we observed two failures after union of femoral neck fracture in younger patients.

[Quadriceps and hamstring strength after anterior cruciate ligament rupture treated operatively with Leeds-Keio prosthesis and without surgery]. / Wydolnosc miesnia czworoglowego uda i miesni zginaczy kolana po uszkodzeniach wiezadla krzyzowego przedniego w ocenie dynamometrycznej i klinicznej.

69 patients with the ACL rupture: 40 non-operated, without functional knee instability, and 29 after the ACL reconstruction using Leeds-Keio prosthesis due to knee instability have been evaluated. Isometric dynamometric examination of the quadriceps and hamstring muscles was performed. The mean strength deficit in non-operated group was: quadriceps--18.48%, hamstring--7.19%, in operated group was: quadriceps--11.87%, hamstring--10.30%. The higher strength deficit of the quadriceps and lower of the hamstring in non-operated patients may be the sign of an adaptational mechanism to the ACL deficiency. No statistical correlation between the strength deficit and the deficit of the thigh circumference 10 cm above the patella was found.